The modern Western society has become, to a large extent, a consumer society; and it is hardly surprising that this should be reflected in the consumption of healthcare.

For many people, health seems to be something that can be ‘bought’ at the doctor’s, and taking pills seems to be more important than adjusting life-style. Our growing reliance on medical science has given us a degree of overconfidence in the miracles that medicine can work. The assumption has grown that, if a disorder can be detected early enough it can be cured.

Extrapolating from this, programmes of screening (examining apparently healthy people to detect disease in the early, pre-symptomatic stages) have become very popular. An example is the United States where the businessman’s annual health-check has become almost routine.

Unfortunately, this approach is not always successful. To be of any real value, screening should not be haphazard, but should concentrate on conditions in which early diagnosis really can affect the treatment and eventual outcome, and in which those most at risk can be easily identified.

Cervical cancer, for example, can be completely cured if it is detected early enough. Regular cervical smears carried out on all women from the age of 25 would undoubtedly minimize mortality from this disorder. Although selective screening is a valuable means of detecting and treating some ‘high risk’ groups of people, it is an ineffective means of prolonging general life expectancy. It is also not very cost-effective in our economy-conscious society. Much more effective have been public health measures such as the clean air bill, and legislation governing, for example, drinking and driving, and the wearing of car seat-belts.

It also seems inconsistent that, on the one hand, advertisements encourage people to drink or smoke and, on the other, substantial amounts of health care money is spent on curing the self-afflicted disorders that are the result of these bad habits.

Unnecessary treatments

Occasionally, doctors are undoubtedly too quick to suggest, or to meet their patients’ demands for, medical or surgical treatment. In Britain, for instance, the increasing costs and diminishing resources of a nationalized health service mean that probably not very many operations are performed unnecessarily. In the United States where health is privatized and there are twice as many surgeons in proportion to the population as in Britain, twice as many operations are performed per head of the population. Hysterectomy (removal of the uterus) is the most widely performed operation of all in the USA and yet most doctors would agree that only rarely is hysterectomy medically necessary.

Patient backlash

Perhaps inevitably, there has been a patient backlash in many advanced countries against what is seen as over-medicalization. Childbirth is a particular example. Good antenatal care and delivery by qualified persons have considerably reduced the number of babies (and women) who die at birth or soon after. The conventional medical view is that although some women are more at risk than others, childbirth is always unpredictable and deliveries should therefore be in hospitals where expertise and resources and mechanical aids are present.

However, many women are uneasy about increasing medical interference in what is supposed to be-a largely natural process.

There has been an astonishing increase in the number of Caesarean sections performed, for example, coupled with the almost universal use of episiotomy in some areas. When equipment and surgical possibilities are available they tend to be used, even if it is only to be ‘on the safe side’ rather than out of necessity. One cause ot the increase in popularity of alternative or complementary health care, is that in a medicalized society the health care that treats the whole person is largely replaced by technical and piecemeal care; and doctors seem to have less and less time to listen to their patients. There is a growing realization of the extent to which an individual’s health lies in his own hands. Indeed, without this element of self-help it is acknowledged that in some cases a ‘cure’ is impossible. There is an increasing recognition, for example, that drug addiction is not a ‘disease’ in any medical sense of the word, but a form of deviant behaviour for which the only real solution is the individual’s own determination that he will be cured. The cigarette smoker who truly wants to give up his addiction will find that almost any method will work; the one who knows he should give up but who does not, in his heart of hearts, really want to give up will try each method in turn – unsuccessfully.

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